ehealth for a Healthier Europe! opportunities for a better use of healthcare resources

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1 ehealth for a Healthier Europe! opportunities for a better use of healthcare resources

2 This study was conducted by Gartner on behalf of The Ministry of Health and Social Affairs in Sweden. Photo: Matton Images

3 ehealth for a Healthier Europe! opportunities for a better use of healthcare resources

4 Executive Summary Results There is a significant healtcare improvment potential using ehealth as a catalyst. For the five political goals used in the study, the technology adoption is lower than 30%. The potential improvements are of such magnitude that they demand both attention and action from all member states. Examples of quantified potentials include: 5 million yearly outpatient prescription errors could be avoided through the use of Electronic Transfer of Prescriptions. 100,000 yearly inpatient adverse drug events could be avoided through Computerised Physician Order Entry and Clinical Decision Support. This would in turn free up 700,000 bed-days yearly, an opportunity for increasing throughput and decreasing waiting times, corresponding to a value of almost 300 million. 9 million bed-days yearly could be freed up through the use of Computer-Based Patient Records, an opportunity for either increasing throughput or decreasing waiting times, corresponding to a value of nearly 3,7 billion. The challenge of locating reliable data was a key issue when performing the study. In medicine, the demand for evidence has always been high and in that light it is paradoxical that key metrics related to healthcare quality, efficiency and availability of care are tracked in a scattered way, if measured at all. Gartner stresses the necessity for each of the member states to: Prioritise ehealth initiatives based on political goals and documented benefits Improve measurement and collection of healthcare statistics related to ehealth Continue to improve and develop present systems, and work on the communication of delivered success Develop methods to evaluate, track and reduce medical errors and wastage of resource Create a culture, which promotes development and praises success 2

5 About this study This study was conducted by Gartner on behalf of The Ministry of Health and Social Affairs in Sweden. The Ministry launched an initiative in 2008 to improve the understanding of how improvements in healthcare can be supported by technology and how these technologies are connected to political goals. This was accomplished by using a new benefit model in which benefits of continued implementation of technologies are calculated based on current medical and technology status. Six member states participated in the study: the Czech Republic, France, the Netherlands, Sweden, Spain and the United Kingdom. The purpose of this report is to provide a summary of the work undertaken, the results and the conclusions reached. About the model A comprehensive model was constructed utilising data from over 60 clinical studies and covering evidence of benefits across 11 ehealth technologies. The as is healthcare situation for each member state was established by gathering over 300 unique clinical data points covering metrics such as utilisation, performance, costs, staffing levels, etc. The degree of technology implementation was estimated via high level self-assessments by subject matter experts at central health agencies within each participating member state. The model demonstrates the connection between political goals, ehealth technologies and potential benefits. In this way it facilitates decision making when prioritising investments in ehealth. The five common political goals identified and used in this study were: Patient Safety, Quality of Care, Availability of Care, Empowerment and Continuity of Care. 3

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7 Table of Contents 1. Introduction 6 2. Challenges for Healthcare 7 3. Can ehealth Contribute? Methodology About the Model Robustness Caveats List of Political Goals, Technologies and Benefits Benefits of ehealth Overview Major Benefits of ehealth Major Contributing Technologies Findings on Clinical Metrics Availability Benefits of ehealth Calculations Improving Patient Safety Increasing Quality of Care Increasing Availability Increasing Empowerment Conclusions and Recommendations 46 Appendices 49 Appendix 1 Methodology 50 Appendix 2 Quantifying Potential Benefits 54 Appendix 3 Political Goals 59 Appendix 4 Technologies 63 Appendix 5 Benefit Details 72 5

8 Introduction 1. Introduction This report is the result of a study conducted by Gartner on behalf of the Swedish Ministry of Health and Social Affairs. The Ministry launched an initiative in 2008 with the objectives to: Make available a concrete example of how to work with a benefits model to analyse how political goals can be realised through ehealth Visualize and quantify fact-based benefits of continued implementation of ehealth in the EU Give partial support for prioritisation of ehealth initiatives Create a stepping stone for further work. The study was conducted during the period December 2008 May 2009 and six member states participated in the study: the Czech Republic, France, the Netherlands, Sweden, Spain and the United Kingdom. The purpose of this report is to provide a summary of the work undertaken, the results and the conclusions reached. For the purpose of this study, ehealth corresponds to the description offered by the European Commission s Information Society: The interaction between patients and health-service providers, institution-to-institution transmission of data, or peer-to peer communication between patients and/or health professionals. Examples include health information networks, electronic health records, telemedicine services, wearable and portable systems which communicate, health portals, and many other ICT based tools assisting disease prevention, diagnosis, treatment, health monitoring and lifestyle management. Medical devices and administrative systems such as purchasing or billing systems are however excluded from the study and from our use of the term ehealth. Further elements excluded from the scope of the study are: infrastructure technologies as required for e.g. communication and security, detailed descriptions of best practices for implementation and estimates of costs for implementation. The disposition of the following chapters is as follows: Chapter 2. Challenges for Healthcare on page 7, outlines the coming challenges for healthcare. Chapter 3. Can ehealth Contribute? on page 10, addresses if and how ehealth can contribute to meet the coming challenges. Chapter 4. Methodology on page 13, introduces the model used in this study and shows how political goals, technologies and benefits can be linked to facilitate decision making. Chapter 5. Benefits of ehealth Overview on page 19, describes results from applying the model to data collected from the six member states. Chapter 6. Benefits of ehealth Calculations on page 29 provides detailed background of calculations and associated assumptions. Chapter 7. Conclusions and Recommendations on page 46, contains conclusions and recommendations for moving forward. 6

9 Challenges for Healthcare 2. Challenges for Healthcare We are all dependent on access to timely and qualitative care. Delivering healthcare services according to the need of the patients is however becoming more and more of a challenge. Policy makers and care delivery organisations must ensure that they can serve a growing demand while improving quality and efficiency and simultaneously transform the healthcare system from physiciancentric to patient-centric. Determining the right solutions and implementation strategies for doing this is complex and will take time. Meanwhile, every delay to implement improvements is associated with a missed opportunity to prevent injuries and deaths. Healthcare affects everyone. Most will come into contact with the healthcare sector in a variety of ways as policy makers, patients, relatives, employees within the sector, or more indirectly, as taxpayers and citizens. According to recent opinion surveys, healthcare is considered essential by EU citizens. In a recent Eurobarometer survey, healthcare was considered the fifth most important issue, trailing issues like economic situation and employment, but considered more important than taxation, housing and education 1. Another important indicator of the status of healthcare in the EU is the recognition of the right of access to healthcare in the Charter of Fundamental Rights of the EU 2. It is also a stated strategy to consider and implement health matters in other policies 3. The total cost of healthcare is also high enough to make it an area of public concern. Since the 1960s, spending on healthcare has grown faster than the gross domestic product in most EU member states 4. For the member states included in this study, it has risen from an average of 3.1% in 1960 to 8.8% in Average Healthcare Spend as % of Gross Domestic Product for Member States in Study Spend on Healthcare (% of Gross Domestic Product) 10% 8% 6% 4% 2% 0% Figure 1. Healthcare Spend for Member States in Study 1 Eurobarometer 70, 2 The Charter of Fundamental Rights of the European Union, 3 Health Strategy Whitepaper, 4 OECD Health Data, 7

10 Challenges for Healthcare There are significant challenges ahead for the healthcare sector. Forecasts indicate that spending on healthcare as a % of GDP will likely continue to rise, potentially climbing to around 15% by This increase in cost is largely driven by an increase in demand, which stems from a steadily increasing life expectancy and a larger proportion of the EU population of pensionable age. Moreover, lifestyles are changing in a way that means citizens generally require a higher and more intensive level of care. Whilst ensuring their ability to both effectively and efficiently meet the increasing demands for care, policy makers and care delivery organisations also need to improve other important aspects of healthcare, such as: Availability (equal access, reduced waiting times and better utilisation of resources) Continuity of care (coordination of activities and information sharing among care providers) Empowerment (patient-centricity, influence and direct involvement in the patient s own care) Patient safety (evidence based healthcare, reduced risk of patient harm) Quality of care (patient satisfaction, effectiveness and efficiency of care service provision) There is, in addition, a need to manage and mitigate new large-scale risks such as pandemics, bioterrorism and health consequences of climate change 6. In summary, it is becoming more challenging to deliver healthcare according to demand, in line with expectations of quality and cost, whilst achieving expectations for improvements in effectiveness and efficiency. The way in which to meet these challenges is not obvious. The EU Health Strategy whitepaper gives one view of this and proposes actions such as: Adoption of a Statement on fundamental health values Promotion of health literacy programmes for different age groups Strengthen mechanisms for surveillance and response to health threats, including review of the remit of the European Centre for Disease prevention and Control. In addition to support such strategic-level initiatives, national agencies, local regions and individual care delivery organisations must continue to manage a balance between tactical and operational considerations, which involves prioritising resources between e.g. recruiting more staff, training already employed staff, acquiring or improving facilities, or lastly investing in process improvements. Improving processes is an especially interesting option to explore as benefits can have an effect on a large scope of delivered services. Minor but overlooked improvements to processes can sometimes have a dramatic effect, e.g. introducing check-lists before and after surgery. In addition, more transformational process improvements must be considered. Such changes are often dependent on technology and implementation comes with higher requirements on organisational and culture change. In light of the range of challenges and the numerous ways to meet them, the issue of prioritising and sequencing initiatives is complex. Planning must include consideration of local factors that could have a high degree of influence, e.g. attitudes, legal systems, methods of financing healthcare, patient identification, current levels of IT maturity and current levels of technology adoption. Some improvements may even be 5 Healthcast 2020: Creating a Sustainable Future 6 Health Strategy Whitepaper, 8

11 Challenges for Healthcare dependent on change to legislation e.g. how delivery organisations are remunerated (payment by results) or the way medical information and errors are handled. The dilemma is that while wanting to make enlightened decisions and avoid hasty, risky and wasteful initiatives, delays may lead to lost opportunities with regards to both reducing costs and preventing injuries and deaths. The delay of getting a particular patient safety-related improvement in place or not could potentially be a matter of hundreds or thousands of lives lost or saved every year. 9

12 Can ehealth Contribute? 3. Can ehealth Contribute? Research shows that organisations that successfully leverage IT can rapidly increase their effectiveness. Results from early adopters of ehealth hint at its potential. Meanwhile, some healthcare organisations have negative experience of failed ehealth projects and are frustrated by the systems currently installed. Such experiences should be reviewed for lessons learnt and should not be allowed to become barriers to progress. Regardless of the pace of adoption, there are both general and healthcare-specific issues that will need to be tackled. In order to move initiatives forward, key stakeholders must create a climate that enables a culture of openness, positive attitude, pragmatism, shared goal-setting and learning. Recent research shows that investment in IT increase the performance spread between leaders and laggards within a sector 7. This implies that IT initiatives, correctly implemented, have the potential to significantly improve the effectiveness of an organisation. More and more specific examples of successful ehealth implementations are emerging which shows that this also is true for the healthcare sector. There is a set of ehealth technologies already enjoying widespread use. The most mature example is Picture Archiving and Communication Systems (PACS). Technologies about to mature include Electronic Transfer of Prescriptions (ETP), Computerbased Patient Records and Electronic Medical Records (CPR/EMR), and Electronic Health Records (EHR). Well-known examples of successful early adopters in the EU include Sweden (ETP 8 ), Denmark (EHR 9 ) and Andalusia (EHR) where diligent technology implementation, alongside transformational change in the culture of medicine has delivered tangible benefits. Outside the EU, leaders such as Kaiser Permanente and The Veterans Health Administration in the US are good examples of organisations making strong use of ehealth. Whilst most organisations currently agree that the potential for benefits of ehealth exists 10, 11, some have painful memories of failed IT projects and are frustrated by the flawed implementation of software now in use. There is also some concern expressed that some systems cause more errors than they are preventing. Errors solely caused by systems themselves are serious and correcting such defects must be an urgent priority. In some cases, when systems are blamed as the cause of errors, in reality the errors arise from inadequate processes and are just made visible through the technology. The ability to detect errors is of clear benefit to care delivery organisations. Focus should be on avoiding preventable issues, to redoubling efforts to use ehealth effectively and to demand better systems which facilitate effective provision of care. In many cases, healthcare IT provides the facility to quickly detect errors which would have occurred regardless of whether a system was in place or not. This is of clear benefit to the care delivery organisation. There is always a risk of 7 Erik Brynjolfsson, Investing In The IT That Makes A Competitive Difference, 8 Apoteket and Stockholm County Council, Sweden, erecept, an eprescribing application, 9 Ib Johansen, E-Health and Implementation of EHR 10 European Commission, Information Society, ehealth is Worth it the economic benefits of implemented ehealth solutions at ten European sites, 11 Barry R. Hieb, Gartner, Stop the Bleeding: Use IT to Achieve Sustained Value in Healthcare, 10

13 Can ehealth Contribute? implementations going awry, focus should be on avoiding preventable issues, and redoubling efforts to use ehealth effectively and to demand better systems which facilitate effective provision of care. Independent of the pace of adoption of ehealth, there are both general and healthcare-specific issues, which need to be tackled. The following examples are issues related to IT implementations that are often brought up as ehealth-specific, but are often seen across many industries: Complexity, e.g. managing dependencies between infrastructure, applications, information and integration. Governance, e.g. ensuring alignment between initiatives and overall organization governance. Local conditions, e.g. balancing central and local motivation, priorities and funding. Stakeholder engagement, e.g. ensuring involvement and acceptance from managers, clinicians and IT staff. Vendor engagement, e.g. ensuring contracts with clear responsibilities and liabilities. Adapting to change, e.g. successfully communicating changes, training staff and ensuring that projects do not become IT projects, but really clinicianled projects aimed at improving ways of working. Measurement, e.g. establishing baseline measurements and agreed success metrics. There are a number of generic methods and best practices that can be used in healthcare, currently being used elsewhere. This said, major transformations of large organisations should not be underestimated and always need to be thoroughly planned and executed. Other issues for implementing and reaping the benefits of ehealth are specific to the healthcare sector. One example is the complexity of medicine itself. Benefits will arise from reducing unnecessary variations in clinical practices, however establishing which variations are in fact unnecessary, and which are matters of clinical judgement requires the formulation of common processes, definitions, clinical pathways, etc. Another key concern is the high sensitivity of medical and personal data and the mechanisms to ensure its safe handling, storage and disposal. This has been a hot topic for a long time, but is now at the forefront owing to data protection legislation at national and EU levels. The issue at present is less related to the availability of security mechanisms in technologies and more about determining the content of the rules, who is responsible for their maintenance and management, who will enforce compliance, and how consent is obtained from patients. It is also a factor of the healthcare sector that evidential proof is held as of the highest importance, and is a key feature of the ehealth debate. This is most likely influenced by the fact that the practice of medicine depends on accurate, complete, and rigorous information and deals in matters of life and death. Both practitioners of management and medicine do however also work and make decisions with incomplete information. Some areas of uncertainty are close to solution, others will not be clarified for some time, and it may not be prudent to delay action until they are clarified. Inconsistencies in terminology used to describe the various technologies and medical outcomes will continue to be an issue. Gaps in the tracking and measurement of important baseline data such as clinical metrics around error density, resource wastage etc. will need to be addressed but doing so will be time consuming. Uncertainties 11

14 Can ehealth Contribute? surrounding the validity of applying study results in different contextual scenarios will also pervade. Though valid concerns, such complications should not be seen as impassable barriers to adoption. Working with evaluation, planning and implementation of IT-enabled change is a process of learning. Aral, Brynjolfsson and Wu propose to view investment in and implementation of IT as a feedback loop, where success breeds success: Firms that successfully implement IT react by investing in more IT. Our work suggests replacing either-or views of causality with a positive feedback loop conceptualization in which successful IT investments initiate a virtuous cycle of investment and gain 12. For such a feedback loop to be effective, a wide group of stakeholders must come together clinicians, policy makers, care delivery organisation managers, solution providers and IT specialists. These groups often have diametrically opposed points of view. For ehealth advances to succeed, they must be implemented within a climate of openness, positive attitude, pragmatism, shared goal-setting and learning. In order to manage expectations and motivation for all stakeholders, it is appropriate to complement traditional quantitative, and financial business-case metrics with objectives that take into account perceived value 13 and are linked to a variety of value categories 14, wide enough to be relevant for all members of the group. 12 Sinan Aral, Erik Brynjolfsson, D.J. Wu, Which Came First, it or Productivity? Virtuous Cycle of Investment and Use in Enterprise Systems, 13 Audry Apfel, A Maverick Approach to the Business Value of IT, 14 Howard Rubin, CIO Magazine, Where s The Beef?, 12

15 Methodology 4. Methodology The model used in this study links political goals, technologies and benefits. It was constructed utilising data from over 60 clinical studies and covering evidence of benefits across 11 ehealth technologies. The as is healthcare situation for each member state was established by gathering over 300 unique clinical data points covering metrics such as utilisation, performance, costs, staffing levels, etc. The degree of technology implementation was estimated via high level self-assessments by subject matter experts at central health agencies within each participating member state. The model demonstrates the connection between political goals, ehealth technologies and potential benefits. In this way it facilitates decision making when prioritising investments in ehealth. The five common political goals identified and used in this study were: Patient Safety, Quality of Care, Availability of Care, Empowerment and Continuity of Care. 4.1 About the Model This study is based on a model developed by Gartner that links political goals, technologies and benefits. The model makes it possible to quantify the potential benefits of continued implementation of ehealth technologies, per member state, by combining: Member state clinical metrics Member state current technology adoption levels Typical levels of improvement enabled by implementation of ehealth technologies, as documented in case studies Each documented benefit has one main enabling technology and is seen as contributing to any number of political goals. The fact that technologies and benefits are linked to political goals makes it possible to analyse which technologies most strongly support particular political goals. The instance of the model used in this study evaluates 5 political goals 11 technologies and 37 benefits. Figure 2 represents the model used in this report and illustrates the relationship between documented benefits, their enabling technologies and the political goals they can contribute to. In this example the political goal (P1) is supported by four technologies (T1 T4). The documented benefits, gathered from clinical studies, are enabled by the corresponding technologies as shown in the figure (T1 enables B1). Benefits in red are used in the report to create the examples of the quantified potential of each ehealth technology in member state specific or collective healthcare scenarios. 13

16 Methodology Political Goal Technology Documented Benefit Quantified Yearly Potential P1 T1 T2 T3 B1 B2 B5 B6 B7 B8 B9 B3 This box shows examples of benefit calculations using, benefits, technology adoption and clinical data from each member state T4 B4 Figure 2. Linking Political Goals, Technologies and Benefits A quantified potential is calculated based on three factors: Clinical Metrics metrics gathered from six EU member states that indicate the current state of various areas of healthcare in these member states. Documented Benefit Benefits reported in case studies are extrapolated and applied to clinical metrics from the six EU member states to calculate the quantified potential of technology in each member state. Level of technology adoption self-assessed levels of technology adoption are applied to the previous calculation to estimate the potential benefit corresponding to the remaining level of adoption for each technology. Clinical Metric. e.g. Number of Adverse Drug Events (ADE) 1 % Technology adoption Remaining level of technology adoption Potential Benefit e.g. Reduction in Number of ADEs Quantified Potential e.g. Potential reduction in Number of ADEs Documented Benefit e.g. 15% reduction in preventable ADEs through CPOE Figure 3. Mechanism for Estimation of Quantified Potential The quantified potential is calculated based on these three factors. Member state specific clinical metrics are multiplied by documented benefits resulting in an estimation of potential benefits. This estimation is then multiplied by the member state specific remaining level of technology adoption to arrive at the quantified potential for that member state. The figures presented in this report are aggregations of member state specific calculations. Financial opportunities are referred to as opportunity saving. These figures does not represent hard savings, rather they imply a political decision on how a released resource should be utilised. i.e. to increase throughput, to increase time with patients, etc. 14

17 Methodology 4.2 Robustness Substantial effort went into making a robust model. Evidence of quantified benefits was gathered through a comprehensive literature review of available research and other essential literature including medical publications, healthcare informatics publications, reports from departments and ministries of Health throughout Europe, studies from medical institutes and case studies on the outcomes of ehealth initiatives in different healthcare organisations; all in all over 60 sources. The healthcare situation for each member state was established by gathering a total of over 300 unique clinical data points covering utilisation, performance, costs, staff, etc. Care was taken to normalise data points from different member states to be able to create aggregated numbers. This data was complemented by interviews held with field experts and professionals within the medical fields supported by input from Gartner healthcare research analyst and consultant community. Gathered data was verified with healthcare representatives of each member state. In cases where data from all participating member states was not available, examples have been limited to individual member states. All aggregated results presented in the report are totals from the participating member states, not extrapolations from one member state to another. 4.3 Caveats The report only provides examples of what could be achieved through continued investment in ehealth technologies. Only quantitative benefits have been taken into consideration in these examples. Qualitative outcomes have not been modelled, nevertheless they should be considered as part of any technology evaluation. It is essential to recognise that the figures presented should not be taken as absolute values, given the uncertainty of the assumptions behind them; however, the estimates generated from the methodology illustrates the order of magnitude of the outcomes that can be expected from ehealth, based on the best information currently available. The levels of technology adoption used to estimate benefits are high level self assessments, provided by subject matter experts at central health agencies within each member state. Gartner analysts and other studies estimate that the actual adoption technology level in many cases is lower. As this study focus on the remaining potential, to high adoptions levels results in conservative estimates. Achieving the potentials estimated typically requires changes in culture, processes and procedures. Costs to achieve these potentials are not calculated. The values do not represent the net value saved, they represent the gross potential. 15

18 Methodology 4.4 List of Political Goals, Technologies and Benefits The Political Goals are defined in Chapter Appendix 3 Political Goals on page 59, Technologies are defined in Chapter Appendix 4 Technologies on page 63, and Benefits are defined in Chapter Appendix 5 Benefit Details on page 72. An outline of these is presented below. The five political goals evaluated in this study are: P1 P2 P3 P4 P5 Patient Safety (evidence based healthcare, reduced risk of patient harm) Quality of Care (patient satisfaction, effectiveness and efficiency of care service provision) Availability (equal access, reduced waiting times and better utilisation of resources) Empowerment (patient-centricity, influence and direct involvement in the patient s own care) Continuity of Care (coordination of activities and information sharing among caregivers) The following eleven technologies are used through this model. These technologies have been evaluated for their potential contribution to the achievement of the political goals introduced above. T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 Electronic Medical Records (EMR)/Computer-Based Patient Records (CPR) Electronic Health Records (EHR) Electronic Appointment Booking Computerised Physician Order Entry (CPOE) Electronic Transfer of Prescription (ETP) Picture Archiving and Communications System (PACS) Personal Health Record (PHR) Patient Portals Telemedicine Business Intelligence (BI) for real time detection of hospital infection patterns Radio Frequency Identification (RFID) and Barcoding 16

19 Methodology The following 37 documented benefits have been identified as a direct result of adoption and usage of the above listed technologies: B1 B2 B3 B4 B5 B6 B7 B8 B9 10.3% reduction in Hospital Acquired Infections (HAI) 17% reduction in Adverse Drug Events (ADE) Up to 83% achievement in the generic compliance rate with the recommended drug orders 84% reduction in missing dose medication errors 60 % reduction in potential adverse drug events (near misses) 7% decrease in number of GP appointments replaced by telephone contacts 22% gain in clinical staff productivity Reduction of 816 inappropriate referrals to secondary care per year per primary care unit 33% reduction of Did Not Attends (DNA) B10 16% reduction in waiting times for first outpatient appointment B11 41% reduction in drug interaction errors B12 39% increase in formulary drug compliance B13 7.2% reductions in cost per prescription as a result of increase in generic fill rates B14 15% reduction in prescription error B15 10% increase in number of patients seen by GP B16 9% reduction in the growth rate of acute admissions B17 32% reduction in diabetic death B18 52% rise in patients with documented self management goals B19 83% reduction in 90 day readmission rate for Congestive Heart Failure (CHF) patients B20 7% reduction in average length of stay in hospital B21 48% reduction in duplicate laboratory/chemistry tests B22 25% reduction in average number of bed days for admissions for chronic conditions. B23 25% reduction in prescribed medication costs B24 19% reduction in hospital admissions for chronic conditions B25 55% reduction in hospital admissions for Congestive Heart Failure (CHF) B % increase in volumes of tests (increase in throughput) B27 88% reduction of film costs B28 60% improvement in radiologist productivity measured in number of tests read per radiologist B29 99% reduction in lost images B30 99% reduction in number of repeat imaging tests B31 9.7% reduction in number of GP appointments B32 50% reduction in admin staff time spent filing and managing forms B33 14% reduction in healthcare costs of smokers B34 35% reduction in number of redundant tests B35 83% reduction in medication errors due to mistaken identity B36 75% reduction in cases of medicines running out where RFID is used for stock control and inventory management B37 20% increase in the number of patients discharged by noon. 17

20 Methodology Other frequently used acronyms include: Care Delivery Organisation (CDO) Chronic Disease Management Systems (CDMS) Clinical Decision Support (CDS) Congestive Heart Failure (CHF) Did Not Attend (DNA) Home Health Monitoring (HHM) Hospital Acquired Infections (HAI) 18

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